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Atrophic Nerve Fibers in Regions of Reduced MIBG Uptake in Doxorubicin Cardiomyopathy

Second Department of Internal Medicine and Department of Radiation, Yamanashi Medical University, Yamanashi, Japan

Correspondence: For correspondence or reprints contact: Hajime Takano, MD, Second Department of Internal Medicine, Yamanashi Medical University, 1110 Simokato Tamaho Nakakoma, Yamanashi 409-38, Japan.

ABSTRACT

A myocardial MIBG-SPECT examination was conducted 2 wk after doxorubicin chemotherapy on a 52-yr-old woman without cardiac symptoms. Despite normal ²⁰¹Tl scintigraphy, reduced MIBG uptake was detected in the apical anterior, inferior and lateral segments of the left ventricle. The patient died of congestive heart failure due to doxorubicin-induced cardiomyopathy 10 mo later. At necropsy, the left ventricle was markedly dilated and the apical anterior, inferior and lateral walls were thin, stiff and whitish. Nerve fibers in the apical inferior wall were atrophic and markedly fibrotic where MIBG uptake was most reduced. Nerve fibers in the septum were normal where MIBG uptake had remained normal. The histologic findings correspond with the findings on the MIBG image. MIBG imaging may detect cardiac sympathetic denervation in doxorubicin-induced cardiomyopathy before cardiac symptoms are manifest and cardiac function deteriorates.

Key Words: doxorubicin cardiomyopathy • iodine-123-MIBG • nerve fiber • single-photon emission computed tomography

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